Communication Methods with Sound for Deaf and Hard of Hearing Children

Many different methods of communication that include sound are available for children who are Deaf or Hard of Hearing. The methods range from sound alone to a combination of sound and vision.

Auditory-verbal communication uses sound only, in the form of speech and hearing. The rationale behind this approach is that most moderately-to-profoundly Deaf children will choose visual input over auditory input when visual input is made available, and that they will also choose manual/visual communication due to difficulty producing intelligible speech. Therefore, visual cues are avoided as much as possible, in order to encourage the child to utilize his/her residual hearing (coupled with assistive devices)¹.

In auditory-verbal habilitation, therapeutic activities are arranged in a hierarchy of easy (e.g. detection of a loud clap) to difficult (e.g. following instructions presented as several steps). For young children, a play therapy approach is utilized¹. For example, a basic one-hour auditory-verbal session with the therapist, child, and parent(s) might proceed like this:

- greeting the child

- testing the child's perception of the Ling sounds (if the child has a cochlear implant) using a face screen or hand cue² to discourage lip reading,

- presenting a new speech sound, 's', through conversation while playing with a pretend snake and other objects specially selected by the therapist

- encouraging the child to make the 'snake sound' (guiding placement of the tongue if needed)

- playing a board game to help the child distinguish 's' from other sounds, beginning with easy contrasts such as 'b', 't' or 'o'. A face screen, stuffed animal, or hand cue may be used.

- practice naming objects that begin with 's'

- saying goodbye to the child, and sending home a set of practice cards and a handout on reinforcing the new sound

Therapy sessions are usually held weekly. Auditory-verbal therapists and parents avoid reinforcing any use of gestures or other visual cues by the child, whether for perception or production. When children who have received auditory-verbal training reach school-age, they are typically mainstreamed into classes with hearing children².

Auditory-verbal therapy is not appropriate for every child³. According to Auditory Verbal^UK, an organization of educators and parents, three factors are critical to this approach:

-- Early diagnosis of hearing loss;

-- Family involvement, providing an environment to maximize use of audition;

-- Partnership of parent, child and professional

These characteristics are essential to any training approach for Deaf/HoH children; however, the definition of 'success' in an auditory-verbal program - full participation in the hearing world using only speech and hearing - means that children whose hearing loss is not detected early, or who do not have sufficient parental involvement, may not be successful. Another important factor is access to technology such as powerful hearing aids/cochlear implants that will maximize the amount of auditory input.

Organizations around the world that support the auditory-verbal approach include⁴:

Auditory Verbal^UK -- http://www.auditoryverbal.org.uk/ -- UK

Alexander Graham Bell Association for the Deaf and Hard of Hearing -- http://www.agbell.org/DesktopDefault.aspx?linkid=1 - U.S. *the primary organization for certification of auditory-verbal therapists

VOICE for hearing impaired children -- http://www.voicefordeafkids.com/default.asp -- Canada

Hear and Say Centre -- http://www.hearandsaycentre.com.au/Index.html -- Australia

The Hearing House -- http://www.hearinghouse.co.nz/ -- New Zealand

I Hear Foundation -- http://www.ihearfoundation.org/index.php -- India

Carel Du Toit Centre -- http://www.careldutoit.co.za/main/main.htm -- South Africa

CLASP Auditory Verbal Center Manila -- http://www.clasp.com.ph/ -- Phillipines

The aural-oral approach is sometimes considered equivalent to auditory-verbal, and in practical application the two may be identical. However, an aural-oral approach to hearing habilitation allows visual cues such as speech/lip reading and gesture to be used in conjunction with audition and speech, unlike the "sound only" emphasis in auditory-verbal therapy.

In order to increase information available through hearing, children are fitted with individualized amplification systems or cochlear implants. Hearing is used to supplement speechreading⁵. About one-third of English sounds are visible on the lips, but to discern the other two-thirds and combine them into recognizable words, the person needs additional input as well as concentration and logic skills. In the aural-oral approach, the additional input is given through hearing⁶.

Children may be educated in separate classes from hearing students but the goal is mainstreaming. A "successful" outcome from aural-oral training is considered to be an individual who can interact in hearing society without the use of an interpreter or other aids. This includes being able to speak intelligibly and to understand speech using hearing and lip reading (plus nonverbal means, such as gesture, used by hearing persons). To benefit from an aural-oral program, the child should have sufficient vision for speechreading and obtain enough information from hearing to differentiate sounds that look alike⁷.

Organization that support aural-oral training:

Alexander Graham Bell Association for the Deaf and Hard of Hearing -- http://www.agbell.org/DesktopDefault.aspx?linkid=1 - U.S.

Taralye -- http://www.taralye.vic.edu.au/index.php?categoryid=12 - Australia

Hear-It -- http://www.hear-it.org/index.dsp -- international

Hands and Voices -- http://www.handsandvoices.org/index.htm -- U.S.

I Hear Foundation -- http://www.ihearfoundation.org/index.php -- India

The terms "total communication" and "simultaneous communication" are often used interchangeably, but technically total communication is a philosophy and simultaneous communication is a method. The philosophy of total communication is that successfully communicating a message is most important, and the exact means used to achieve that goal is less important. Thus, a conversation using this philosophy may include speech, sign, gesture, body language, facial expressions, eye movements, pictures, or writing. In certain cases, especially in therapeutic settings, even touch may play a part⁸.

Simultaneous communication has the specific requirement that all messages are spoken and signed simultaneously - word for word, if possible. Since this is not always possible with languages such as British and American Sign Languages, which do not have word for word analogues with speech, many simultaneous communicators use a form of Signed Exact English (S.E.E.)⁹.

In S.E.E., signs are presented using English word order, and additional signs not present in the sign language itself are added to represent inflections such as the "-ing" ending. Since the typical English speaker's voice drops at the end of a word, language components such as inflections and suffixes may be inaudible. S.E.E. allows the Deaf/HoH person to see the elements that cannot be heard¹⁰.

In schools, classes that use total communication may include hearing children, but many do not. However, the total communication approach has proven to be effective for hearing children with other issues such as autism, brain injury, and developmental disabilities. Options for communication are increased, alleviating the frustration felt by many children who are Deaf or developmentally disabled and subsequently improving behavior issues. Simultaneous communication can also help speed the acquisition of language, according to some studies. Brain scans of children in a simultaneous speech/sign conversation indicate that both speech and sign stimulate the brain's language area, usually located near the left temple¹¹.

Total communication is often the best method for children who a) are not able to achieve significant levels of hearing with traditional hearing aids or cochlear implants; b) have developmental disabilities; or c) want to learn to speak and to sign so that they will have increased options when they become adults. Some critics state that children in total communication programs do not learn either sign or English very well. This is seen as a cultural liability, since they may not fit in well with hearing culture or Deaf culture.

Organizations supporting total/simultaneous communication:

S.E.E. Center -- http://www.seecenter.org/ -- U.S.

The Australian Signed English Site - http://www.sign.com.au/ -- Australia

Signed Language -- http://www.signedlanguage.co.uk/SignSupportedEnglish.html --UK (Sign Supported English)

American Society for Deaf Children -- http://www.deafchildren.org/default.aspx -- U.S.

Hands and Voices -- http://www.handsandvoices.org/index.htm -- U.S.

Cued speech is a system of hand signals that, combined with lip reading, visually illustrate the phonetic components of speech. Thus, this communication method is unique in that it deliberately concentrates on recognition of speech sounds rather than on communication of words or phrases holistically. Cued speech can be viewed as phonics instruction for the Deaf. Like the phonics method, cued speech was developed to increase reading ability. It was developed in 1966 by Dr. R. Orin Cornett at Gallaudet University to improve the typically low reading scores of Deaf students¹².

Only about 30% of speech sounds are discernible on the lips. The other 70% must be inferred through vocabulary knowledge or context. This is not as difficult for those who become Deaf after acquiring speech (post-lingually Deafened), but for pre-lingually Deafened children, it is a serious problem. Hearing aids, including cochlear implants, may not provide enough auditory information to fill in the gap¹³.

Cueing makes the additional phonetic information visible through the use of 8 different hand signs in 4 different placements near the face. Because it is based on sounds rather than words, cued speech can be used for virtually any human language, with adaptation of the cues for the distinctive sounds of that language. The method has (so far) been adapted for over 60 languages and dialects. For example, cue charts available from the National Cued Speech Association include the following: American-English, Arabic, British-English, Marathi, Modern Hebrew, Spanish, and Urdu¹⁴.

Although cueing is gaining in popularity, it is not as well-known as other systems. Deaf adults using sign language may be concerned that cueing will replace their language. At the other end of the spectrum, advocates of auditory-only education believe that the addition of any visual information at all will negatively impact the child's ability to speak and learn spoken language. However, research has suggested just the opposite - children who are familiar with cueing develop better speech, especially with a cochlear implant. Also, they can still use sign language, if they choose, because they have acquired facility with manual expression. Many individuals who cue also use ASL or the sign language of their region¹⁵.

Organizations supporting cued speech:

National Cued Speech Association -- http://www.cuedspeech.org/default.asp -- U.S. and worldwide

Cued Speech -- http://www.cuedspeech.co.uk/home.htm -- UK

L'Association de Langage Parlé Complété (ALPC) -- http://www.alpc.asso.fr/ -- France

L'Association de Langage Parlé Complété (Belgique) -- www.lpcbelgique.be -- Belgium

Método Oral Complementado (MOC) -- http://www.uma.es/moc/ -- Spain

Português Falado Complementado (Cued Speech) -- http://www.dailycues.com/PFC/intro.html -- Portugal

Lip or speech reading is a technique by which individuals discern words based on the shapes made by the lips and mouth of the person speaking. In good conditions - a well-lit room, the speaker's face unobscured - about 30-40% of speech sounds can be identified. Thus, even an experienced speech reader will understand less than half the words in a typical sentence¹⁶.

Speech reading is usually combined with other techniques, such as auditory training or cued speech, to be successful at facilitating communication. This is especially true for young Deaf children¹⁸. Adults who become Deaf or Hard of Hearing after years of experience with spoken language are the most successful at speech reading because they can put it in the context of prior language knowledge. The child who experiences Deafness before learning language has no context in which to place the input from speech reading. Therefore, he or she will be unable to infer which words and phrases are most likely being said¹⁷.

Lip reading also requires intense concentration and logical thinking, skills which may not be accessible to young children. In addition, lip reading is most effective in one to one conversation; a group setting where the speaker changes rapidly will be very hard to follow¹⁸.

Speech reading can be used by children, however, if it is combined with use of aided residual hearing (hearing aids, cochlear implants) and certain coping strategies, such as taking breaks to reduce fatigue, standing with the light behind the speech reader, and using contextual clues¹⁹.

Organizations that support speech/lip reading:

Alexander Graham Bell Association for the Deaf and Hard of Hearing -- http://www.agbell.org/DesktopDefault.aspx -- U.S. and worldwide

Hear-It -- http://www.hear-it.org/index.dsp -- international

Hands and Voices -- http://www.handsandvoices.org/index.htm -- U.S.

I Hear Foundation -- http://www.ihearfoundation.org/index.php -- India

Most local agencies that serve Deaf/HoH people have resources for speech reading available.

References:

1. AG Bell Association. (2005). Auditory-Verbal Method. Retrieved March 17, 2008 from http://www.agbell.org/DesktopDefault.aspx?p=Auditory-Verbal_Method.

2. Hear and Say Centre. (n.d.). What is the Auditory-Verbal Approach?. Retrieved March 17, 2008 from http://www.hearandsaycentre.com.au/AV-approach.html.

3. Auditory Verbal UK. (2000). The AV Approach: What is Auditory Verbal Therapy? Retrieved March 17, 2008 from http://www.auditoryverbal.org.uk/.

4. Listen-Up!. (n.d.). Auditory-Oral/Verbal Programs. Retrieved March 17, 2008 from http://www.listen-up.org/oral/provider3.htm#safr.

5. Lim, Stacey. (February, 2006). Auditory-oral. Retrieved March 18, 2008 from http://www.auditoryoptions.org/auditory-oral.htm.

6. DeafLinx. (1998). Auditory/Oral options. Retrieved March 18, 2008 from http://www.deaflinx.com/DeafEd/OptionsGuide/Oralism.html.

7. Stone, Patrick. (1997). Communication Strategies - Auditory/Oral. Retrieved March 18, 2008 from http://www.helpkidshear.org/resources/education/comm/oral.htm.

8. Beginnings. (2008). Total Communication. Retrieved March 18, 2008 from http://www.ncbegin.org/communication_options/total_communication.shtml.

9. Berke, Jamie. (January, 2008). What is simultaneous communication? Retrieved March 18, 2008 from http://deafness.about.com/cs/totalcomm/f/simcom.htm.

10. S.E.E. Center. (n.d.). Frequently asked questions. Retrieved March 18, 2008 from http://www.seecenter.org/faq.htm.

11. Schaeffer, Benson. (2008). Signed speech or simultaneous communication. Retrieved March 18, 2008 from http://www.autism.com/families/therapy/sign.htm.

12. Cued Speech Information and Resources. (n.d.). What is cued speech? Retrieved March 29, 2008 from http://www.cuedspeech.info/whatis.html.

13. Cued Speech UK. (n.d.). What problems does cued speech seek to solve? Retrieved March 29, 2008 from http://www.cuedspeech.co.uk/home.htm.

14. National Cued Speech Association. (n.d.). Cued speech definition and cue charts. Retrieved March 29, 2008 from http://www.cuedspeech.org/sub/cued/default.asp.

15. Bien, Jennifer. (2006). Cued speech video. Retrieved March 29, 2008 from http://youtube.com/watch?v=plPw4H-ZsMg.

16. CDC. (n.d.). Speech reading. Retrieved March 31, 2008 from http://www.cdc.gov/ncbddd/ehdi/CDROM/building/speech_reading.html.

17. Wikipedia. (2008) Lip reading. Retrieved March 31, 2008 from http://en.wikipedia.org/wiki/Lip_reading.

18. Open University. (2006). Students who lip-read. Retrieved March 31, 2008 from http://www.open.ac.uk/inclusiveteaching/pages/understanding-and-awareness/students-who-lip-read.php.

19. Center for Hearing Loss Help. (2008). Speechreading (Lip-reading). Retrieved March 31, 2008 from http://www.hearinglosshelp.com/articles/speechreading.htm.